MEDICARE: BRUCE RANDOLPH WHITING PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY3260	FL

General Provider Information

NPI Number	:	1073631420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE RANDOLPH WHITING PH.D.

Provider Business Mailing Address
First Line	:	3131 LAKESTONE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1120
Country	:	US
Telephone Number	:	813-962-4701
Fax Number	:	813-962-4701

Provider Business Practice Location Address
First Line	:	5221 EHRLICH RD STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-2006
Country	:	US
Telephone Number	:	813-960-8378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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